Variations in treatment practices among pediatric solid tumor patients in Japan.

Abstract

e17656 Background: Care of pediatric cancer patients is only mildly centralized in Japan, and it is not known whether this has led to variations in treatment practices for pediatric solid tumor patients. We aimed to investigate where practice variations exist among pediatric solid tumor patients, by evaluating the treatments patients received in eight pediatric solid tumors that have Japanese clinical guidelines. Methods: Using a database linking hospital-based cancer registry and administrative claims data obtained from 210 cancer treatment hospitals, we identified 20 hepatoblastoma (HB), 68 neuroblastoma (NB), 28 retinoblastoma (RB), 24 nephroblastoma (WT), 20 rhabdomyosarcoma (RMS), 14 Ewing’s sarcoma, 32 osteosarcoma, and 56 central nervous system germ cell tumor (CNSGCT) patients who were diagnosed from 69 hospitals in 2012. We reviewed each patient’s chemotherapy regimens, radiation therapy schedules, and surgical procedures using administrative claims data from September 2011 to December 2013. Results: Most pediatric solid tumor patients received treatment in concordance with clinical guidelines for their first course of treatment. For instance, first-line chemotherapy for HB were cisplatin (CDDP) + pirarubicin (66%) and CDDP + doxorubicin (DXR) ± carboplatin (33%). However, treatment practices varied greatly for both primary and recurrent CNSGCT patients, as well as patients receiving second and third-line chemotherapies. About a quarter of CNSGCT patients received resection or radiation alone as their first treatment, but a greater proportion of patients received surgery followed by various adjuvant chemotherapies or radiation therapy, and neoadjuvant chemotherapy followed by radiation. Regimens for recurrent tumors varied greatly, such that all recurrent RMS patients received different chemotherapy regimens. Conclusions: Despite lack of centralization of care among pediatric solid tumor patients, our study showed that the majority of patients were receiving treatments in concordance with clinical guidelines. However, practice variations existed in CNSGCTs and patients receiving second and third-line chemotherapies, which suggest that centralization of care may be necessary for these patients.